SA Prison Health Services Caring for Prisoners Shaping the future of health with world-class care and world-class research . We acknowledge and respect the Traditional Custodians whose ancestral land the Central Adelaide Local Health Network (CALHN) provides services on. We acknowledge the deep feelings of attachment and relationship of Aboriginal and Torres Strait Islander peoples to country. >Central Adelaide Local Health Network (CALHN) came into effect on 1 July 2011 as a directorate of SA Health. >South Australian Prison Health Service >The SAPHS Director of Nursing reports directly to the CALHN Executive Director of Mental Health / Prison Health. 3 Primary Health Care Within Prison SAPHS Model of Care •Aim Community Equivalence •Detection, assessment and intervention •Prompt and effective treatment •Community standard of care •Prevention measures •Health education •Continuity of care in the community via collaboration with local health care providers 4 Reducing Health Ineqaulities “Access to health is a basic human right not a privilege” —Recognise impact of economic and social policies and conditions on health. —Physical, social and economic environs impact on health and wellbeing of individuals. —Socioeconomic status a key social determinant of health explaining the inequality between the rich and the poor 5 Yatala Labour Prison Health Centre Adelaide Remand Health Port Augusta Prison Health Clinic (24hr 12 Inpatient beds) Centre 576 Prisoners (24 hr 10 inpatientAdelaide Remand HealthCentre beds) 592 Male Prisoners 274 Prisoners 25 Female Prisoners Health Clinics •Nursing •Medical Cit ARC / PAP / YLP •Psychiatrist Patient Contact Hours •Dental Services • 0830 – 1130 •Physio •1300 - 1600 •Sites Specialised Clinics 6 Adelaide Remand Centre (ARC) - SERCO Port Augusta Prison (PAP) Yatala Labour Prison (YLP) YLP Health Centre / High Dependency Unit Adelaide Womens Prison Cadell Training Mobilong Prison Port Lincoln Prison Mount Gambier 176 Prisoners Centre Health Clinic Health Clinic Prison Adelaide Pre-Release Clinic Health Clinic 472 Prisoners 178 Prisoners 653 Prisoners 80 Prisoners 210 Prisoners 10 AWP Cadell Training Centre (CTC) Mobilong Prison (MOB) Port Lincoln Prison (PLP) MGP (G4S) South Australia Adult Prisoner Numbers 49% of adults entering a prison within Australia report that they have been told by a health professional that they have a mental health disorder1. Prisoners can be in a cell for up to 23 hours a day in some prison environments. 16 1. Australian Institute of Health and Welfare, 2018, The Health of Australia’s Prisoners, Australian Government, Canberra 17 The Role of the Prison Health Nurse SAPHS Nurses undertake the same tasks as they would in any community primary health care setting including: Comprehensive clinical assessments of all new prisoners Coordination, triage and/or delivery of health clinics Medication management Assessment and management of high risk patients Management and treatment of chronic conditions Responding to medical emergencies Professional practice and portfolio management 18 SAPHS Nursing Led Journey of Care Stage One - Entry / Admission to Prison Assessment (Health Risk Assessment/ Health Needs Determination) Stage Two – Health Summary (Transfers / Discharge / Assessment / Care Planning / ISBAR Clinical Handover / Inter health Service Facility transfers / Immunisation record / ROI responses to GP requests) Stage Three - Clinical Health Care / Pathways (Health Care Planning) Stage Four - Discharge (Release) Planning Nursing Assessment 19 Prisoner Morbidity and Mortality Chronic Disease Cardiac / Respiratory Disease Mental Health Conditions Musculoskeletal conditions Drug / Substance Abuse Infectious Diseases Ageing Trauma inc. Deliberate harm to self or others Surgical Condition ENT Foreign body / ingestions / hoarding 20 Comprehensive Patient Health Assessment HEALTH ASSESSMENT One HEALTH ASSESSMENT Two Primary Survey Head & Face DRABCDE / DRSABCD (BLS) Inspect - Deformities; Infestations; Secondary Survey Symmetry; OLDCARTS Palpate - Swelling (lymph nodes) Mental Status Examination Primary Survey Past Medical History / Meds Psychosocial History Smoking Eyes Nutrition Alcohol use Illicit drug use Inspect - Eyelids, conjunctiva, sclera, (ABCAPC) Occupational history iris, pupil Religious, spiritual and cultural beliefs Test - visual acuity General Observation Ears Inspect - External ear – shape, A – appearance Unconscious Patient (BLS) Posture & movement colour, size, lesions Facial expression Internal ear – tympanic membrane, Posture, body movement D R S A B C D In teraction swelling, infection, wax, foreign body, Colour, diaphoresis bony growthsPalpate – external ear, mastoid bone, lymph nodes of neck Vital Signs TPR, BP, SaO2, BGL, UA, Dress, grooming and hygiene Conscious Patient Nose & Sinuses Inspect – symmetry Height, Weight, BMI, Waist Circ. of nose, breath through nose, discharge Mental Status Palpate - frontal & maxillary sinuses Nutrition, wasting D R A B C D E ABCAPC Neurological AVPU GCS – Mouth & Throat Inspect – odour, lips B – behaviour Attitude /Rapport/ Secondary Survey Eyes Open (1-4) & mucosa; gums; tongue; tonsils; Best Verbal Response (1-5) swallow; gag; taste; reflux Facial expression, Speech OLDCARTS B est Motor Response (1 - 6) Integumentary Neck Inspect – skin & colour; muscles; Inspect - Colour, Oedema, Rashes, trachea; thyroid; lymph nodesPalpate - Engagement, attention Presenting Concerns Lesions, Palpate - Temperature, muscles; lymph nodes/glands Texture, Turgour .C – cognition Insight Judgement O – Onset HEALTH ASSESSMENT Three HEALTH ASSESSMENT Four Arms & Hands Inspect – nails; muscle Legs & Feet Inspect – nails; muscle Thought processes & content L – Location size; deformity Palpate – texture; joints; size; defo rmity; veins; hair distribution temperature; pulses Palpate – texture; joints; temperature; Mini Mental State Exam D – Duration Assess - ROM; Cap re fill CWSM – pulses Assess - ROM; Cap refill Colour, Warmth, Sensitivity & Movement CWSM – Colour, Warmth, Sensitivity & Movement A – affect Mood & affect, anxiety C - Characteristics Anterio r Thorax Inspect – Size & shape Genitalia of chest wall; angle of ribs, use of Inspect - discharge accessory muscles Inguinal Inspect – Inguinal lymph Screening for suicidal thoughts A – Aggravating Factors Auscultate – anterior thorax; identify nodes; inguinal hernias bilateral breath sounds; wheeze; crackles Palpate – inguinal lymph nodes; Palpate – Anterior thorax femoral pulses P – perceptions Though Content R – Relieving Factors Posterior Thorax Inspect – Cervical, Care Planning Discuss findings with Thoracic & Lumbar Spine; size & shape patient Hallucinations T – Treatment of chest wall; shoulders; scapula • Negotiate plan of care Auscultate – posterior & lateral thorax • Carry out immediate interventions Palpate - Spine • Arrange R/V by M.O. if required Delusions S – Signs / Symptoms / Other • Refer appropriately Handover to other staff C – (level of) consciousness Consider effect on patient, patient’s Abdomen Inspect – size; shape; colour; pigmentation; scars; stretch marks; Documentation Record in systems visible peristalsis; masses; pulsations; • Identify problems & record in order of Alertness, orientation, understanding of problem Prioritise umbilicus priority Auscultate – bowel sounds over each • Initial treatment and plan of care quadrant Palpate – each quadrant; soft; Ongoing short & long term plan 21 attention,concentration other concerns rigid; rebound tenderness; pain; guarding including monitoring Provide Nursing Care in Custody Is a Balancing Act Information Sharing Guidelines Transfer to Hospital 22 Prisoners and Hepatitis C The prevalence of Hepatitis C in the general Australian population is 1-1.5% in the prison setting it is as high as 45%. 23 Psychosis Medication – Assisted Treatment for Opioid Dependence (MATOD) Benefits – Treat Opioid dependence, prevent overdose, reduces harm, reduction in recidivism Treatment Options – Maintenance therapy or pre-release treatment . Officers Role – Supervision Prisoners Role – to take the medication as per their signed contract 26 Health Video Conferencing MATOD Clinics Pain Clinics OPD Clinics Forensic Mental Health Clinic Infectious Diseases Clinic General Medicine Education / Training Burns / Spinal/ Colorectal 27 SAPHS Mental Health Services Notice of Concern (NOC) High Risk Assessment Team (HRAT) HRAT / Mental Health Review OACIS / CBIS Forensic Mental Health Security / Safety. Be aware at all times of your: > Physical (personal) security > Relational Security > Procedural Security > Professional Security 29 Contraband 30 Model of Care for Aboriginal Prisoner Health and Wellbeing for South Australia. Aboriginal people within prisons have complex health needs. The isolation from family and community compounds the profound intergenerational trauma, associated grief and loss, and resulting mental illness and other chronic health conditions, such as diabetes, heart and respiratory diseases, cancer and substance abuse disorders. This make the care of Aboriginal prisoners challenging, and therefore needing careful consideration and management in terms of risks to their health and wellbeing while in prison. 31 Source: pg. 4. Model of Care for Aboriginal Prisoner Health and Wellbeing for South Australia. 2017. Prisoners In Hospital No visitors Don’t No phone calls Under direct supervision > Discuss appointments Secured > Contact family members > Be alone without an officer nearby > Leave equipment unattended > Tolerate verbal abuse or rudeness 32 Prisoners In the Operating Theatre > Security Level / No of Restraints > DCS / G4s officer in attendence > Anaesthetic induction > Release of restraints > Officer visual site of prisoner > O/T Procedure > Recovery > Application of restraints 33 Point of Call >First point of contact >Able to liaise with all prison sites >Provide accurate and up to date information between prison sites and hospitals >Facilitate individualised discharge planning SAPHS Liaison Nurse Phone: 7002 3110 Email: Health:[email protected] 34 Questions .